The Illusion of Sustainability

Project Overview:
This study attempts to bring systematic empirical evidence to bear on the increased focus on foreign assistance on the concept of sustainability. The idea of sustainability has affected a wide variety of development policies. In public health, for example, advocates of sustainability concentrate on health education, community mobilization, and cost-recovery from program beneficiaries, rather than simply concentrating on medical treatment subsidies-even though the latter may generate positive externalities.

Building on the evaluation of the Primary School Deworming Project (PSDP) in Western Kenya, this study analyzed several de-worming interventions, including free provision of de-worming drugs as well as numerous "sustainable" approaches such as cost sharing, health education, and verbal commitments (a mobilization technique).

Sample:
75 primary schools in Busia district in Kenya's Western Province

Main Results:

• Overall, the results of this study suggest there may be no alternative to continued subsidies for de-worming.
• Providing medicine to treat worms was extremely cost-effective, although medicine must be provided twice per year indefinitely in order to keep children worm-free.
• An effort to promote sustainability by educating the Kenyan schoolchildren on worm prevention was found to have no impact on child worm prevention behaviors - and thus child health is likely to be worsened to the extent that funds are diverted from medical treatment into health education in this setting.
• A verbal commitment "mobilization" intervention - which asked people to commit in advance to adopt the de-worming drugs, taking advantage of a finding from social psychology that individuals strive for consistency in their statements and their actions - had no impact on treatment rates.
• Take-up was highly sensitive to drug cost: the introduction of a small fee led to a sharp 80 percent reduction in take-up (relative to free treatment).

Principal Investigators:
Michael Kremer (Harvard) and Edward Miguel

Academic Papers:

Michael Kremer and Edward Miguel. forthcoming. The Illusion of Sustainability. Quarterly Journal of Economics.

Working Papers:

Edward Miguel and Michael Kremer. 2003. Networks, Social Learning, and Technology Adoption: The Case of Deworming Drugs in Kenya.

In the News:

Liberation (France) article: Esther Duflo, "Reinventer le developpement durable", February 13, 2006